HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COI
Date:
,-D FOR APPLICATION TO BE ACCEPTED
Permit Number:
—1 RECEIVED
� o BAN 12 20
Building Permit Application St. Luc; `2
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
Commercial
CBDG Funding
Pnty
errnng(/
Residential
J Lot No.-,,
Block No.
New Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
LEl'ectric vPlumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: %LD Sq. Ft. of First Floor:
Cost of Construction: $j�i �� . Utilities: _ Sewer _ Septic Building Height:
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Phone No.
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED
If value of HAVC is $7,500 or more, a RECORDED Not!
Name: f'��ij,r✓✓' % �Y//f/�C_J
Company: ,p r i
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Address:
City: > .6/ ,�/�/��� State•-
.
E- Zip Code: 5 Fax:
Phone No 4Y " v` zW
E-Mail Qlo �/ �a - i�
State or County License
:e of Commencement is required.
Commencement is required.
An
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DESIGN /E I
ER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name-
Name:
Address:
2eL
Address:
City:
if State:
City: State:
Zim
Phone e2,0
Zip: Phone:
FEE SIMPLE TITLE
HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
- -
City:
Zip:
Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such ,--
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt frorry undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
- with -lender or n attorney before-commencin work -or recording our Notice of Commencement. .. * : 7-
Signature of Owner/ essee/Contractor asACent for Owner
STATE OF FLORIDA
-
COUNTY OF �'
Sworn to.(or affi d) and subscribed befor me of "Physical Presence or
this day 20�by
Online Notarization
of
-- c-7 Q
Name o person making statement.
Person Kn n OR Pro Id ntification�
�.
10 141,
SHERRI FEHLMAN
Typ of Id e if' ation Produce
Commission # GG 187160
Expires March 14, 2022
BondedTNu5W9etN0tWSer4I
(Signet a of Notary Publi ate of rida)
Commission No. (Seal)
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KeV 5/LU/L1